| NPI | 1104331396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175685) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024175685) |
| 363L00000X Nurse Practitioner (Licence: TN 24317) | |
| Enumeration Date | 2017-12-10 |
| Last Update Date | 2026-01-19 |